December 22, 2010

Today I want to expand on the topic of Rolfing® Structural Integration and other bodywork modalities for musicians. (Yesterday I posted about Leon Fleisher, the renowned pianist whose career was truncated by focal dystonia until he found a way to manage the disorder through Rolfing® Structural Integration and botox injections to the affected muscles; you can read that here.)

The positioning of the body to play many musical instruments is asymmetrical. For example, playing a guitar or double bass, one arm is up, and one is down, and each does something different – fretting versus plucking, strumming, or bowing. Or the violin, where the head and chin tuck to the instrument. While playing the piano seems symmetrical, I found it interesting that in Fleisher's interview he attributed his focal dystonia to the fact that the affected fingers – the fourth and fifth fingers of his right hand – play the keys that hit the piano lyre's shorter strings. Shorter strings have less resonance, and the fourth and fifth fingers are generally weaker, so Fleisher says you have to work harder to play these keys.

Focal Dystonia

Fleisher's ailment is focal dystonia, a neurological movement disorder that has no cure but can be managed by a regimen that includes botox injections and Rolfing sessions. Fleisher reports that 10,000 musicians around the world suffer from focal dystonia.

Repetitive Motion Injuries / Tendonitis

More typically with musicians I see issues akin to repetitive motion injuries and tendonitis. Practicing and playing hours a day will use the same muscle groups over and over, with the potential for contracted muscles, localized fascial shortening around them, and entrapped/inflamed nerves. This type of situation responds well to hands-on Rolfing Structural Integration sessions, as well as manual therapy for the nerves. This work is best done in conjunction with movement therapies for reasons discussed below.

Rolf Movement® and Other Movement Modalities

In an article in Structural Integration: The Journal of the Rolf Institute, Rolfer™ Elmar Abram reported working with a few musicians who had the diagnosis of focal dystonia, but whose limitations disappeared when they were coached to play their instruments differently using Rolf Movement® Integration techniques. In some cases it had to do with how they played their instruments in terms of posture and alignment, in other cases there was a deeper mind-body issue involved. This shows how much habit affects function, whether it is back pain from a habit of poor sitting posture or other body issues from the habitual way a musician holds and plays his instrument. And it is not surprising that there can be mind-body issues involved, particularly with professional musicians who are under tremendous pressure from an early age to develop and master their craft.

December 21, 2010

Today I listened to an interview with pianist Leon Fleisher where he discusses his memoirMy Nine Lives: A Memoir of Many Careers in Music and discusses how Rolfing® Structural Integration is one of the two primary therapies he uses to keep his right hand functional, despite suffering from focal dystonia.

In 1963, Fleisher was a renowned pianist scheduled to tour Russia as soloist with a leading U.S. symphony. He had to cancel the tour because he lost the use of the fourth and fith fingers of his right hand, obviously devastating for a musician. The problem was focal dystonia, a neurological movement disorder, although it wasn't diagnosed for years. As he could no longer perform, he had to switch his career to teaching music, conducting, and learning to perform the one-handed repertoire for piano. To try to regain use of his right hand, he tried many therapies over thirty years. Although there is no cure for focal dystonia, Fleisher has found a combination of therapies that allowed him to once again play and perform with two hands: he gets Rolfing work the day before performing, and botox injections to the contracted muscles every four months (this paralyzes the contracted muscle, which allows the opposing muscle to function). Fleisher reports that "Rolfing is a very healthy modality of physical therapy, thanks to both of them i'm a functioning two-handed pianist."

The Wikipedia entry for Leon Fleisher notes that when he received the 2007 Kennedy center honors he was described as "a consummate musician whose career is a moving testament to the life-affirming power of art." Although a devastating injury or ailment may change one's external reality, Fleisher shows us what can be accomplished with passion, adaptability, and the curiosity to explore alternatives.

Another longer audio interview by Diane Rehm is here, where Fleisher and his co-author share much more about his background as a musician, and how he tried "everything from aromatherapy to Zen Buddhism" to heal his focal dystonia. You can read an earlier interview here, from Structural Integration: The Journal of the Rolf Institute.

December 20, 2010

I love this quote from Rolf Movement ® Instructor Monica Caspari): "As Rolfers™, we are after grace, pleasure, aliveness, and coherence of the body in motion. Joy and happiness are more important than perfection."

While Ida Rolf stated the goal of Rolfing® Structural Integration as aligning the body in gravity, that alignment is not a rigid goal but rather a responsive and alive dynamism that the body expresses when it is open and balanced. It is said that Dr. Rolf hated the word "posture," because to her that suggested trying to stand up straight. Her goal in working the fascial system through a Rolfing® Structural Integration series was to restore proper relationships of body segments, which frees the movement of energy so that you feel the force of gravity as something that lifts you into alignment rather than drags you down. It sounds somewhat metaphysical, yet Rolfing clients report this again and again in words like "my body wants to stand up straight" and "I feel lighter."

December 14, 2010

I very often see clients who complain of reduced range of motion (ROM) in the neck (cervical spine). Oftentimes, reduced neck ROM means neck pain as well, or headaches. I find that I can generally bring back good ROM using a combination of Rolfing® Structural Integration and craniosacral work. Sometimes visceral work is needed, or manual therapy for the nerves. Finding a body therapist trained in all of these modalities is your best bet, as they can address the problem whatever its source is.

What Causes Neck ROM Problems?

There are three key motions for the spine: forward- and backward-bending, side-bending, and rotation. Any of these can be reduced by

an auto accident (especially whiplash),

sleeping in an uncomfortable position,

a bad fall,

habitually having your head turned one way (eg., your computer monitor is to your right),

holding the phone to your ear with a shoulder,

a forward-head posture, or

tight muscles.

Think for a moment about a whiplash. Say you are rear-ended while stopped at a traffic signal and your head is turned right because you are saying something to your friend in the passenger seat. Not only are the muscles at the front and back of the neck stressed, because your head is turned, a side-to-side imbalance can also set in, making it more difficult to turn your head one way.

What Kind of Treatment Helps?

Chiropractic work is excellent in these cases, as there is sometimes a vertebrae "out," but the issue may not fully resolve without soft-tissue work like Rolfing sessions, as it's an imbalance in the muscle/fascial tension on the vertebrae that holds them out of place. (This is why people often need less chiropractic care after they do Rolfing sessions: the newly balanced soft tissue allows the vertebrae to hold adjustments better.)

More severe restrictions can involve the dural tube (the "stocking" of fascia that surrounds the spinal cord), which responds to craniosacral work. Sometimes the ligaments that suspend the pleura of the lungs are also involved, as they attach directly to the 7th cervical vertebra; in this case, I do visceral work as well.

I also encourage clients to consider acupuncture as it can be of great assistance. For ongoing maintenance, a yoga practice is excellent.

How Many Sessions Are Needed?

In minor cases, one session will usually fix a "kinked" neck. With a major injury, repeated sessions are often needed, but you should get some immediate relief from the first session and see incremental progress with each session. In Washington and many other states, auto insurance policies will pay for your care after an auto accident, as will worker's compensation in work injuries. I will bill these insurances directly, and so will many other Rolfers™.

With good treatment, you can recover neck ROM in most cases where the problem is musculoskeletal. Your neck will not be a flexible as the chicken in this video below (there's something unique to chicken anatomy), but it might feel this loose!

November 26, 2010

As I'm a Rolfer™, most of the clients coming into my Seattle bodywork practice are addressing posture or pain in some fashion – even if their bodies function pretty well, they want them to function better. This is a great goal, and Rolfing® Structural Integration in particular works to optimize the body's structure in a way that serves this goal. As do craniosacral work (for headaches, TMJ, whiplash, auto injury) and visceral work (implicit in many postural issues and often a "missing piece" when someone has a stubborn pain issue).

In my practice one of my goals is "mind-body integration," and with yesterday being Thanksgiving I reflected on how our attitudes towards our bodies can affect how easily we can recover from injury and change old patterns. This is not to say that pain is "all in your head." After all, an auto accident or other injury, or pain from a postural complaint, can definitely turn aspects of your life downhill. Rather, it's to say that viewing your body in an appreciative way, for all that it does for you, gives holding and context for change and optimization to occur, and compassion for the ways we are suffering.

For example, I'll never forget a client of mine who was dealing with alot of physical pain – from fibromyalgia, and from an acute knee injury. She also had emotional pain from a recent ugly divorce. One day during a session she said with vehemence "I hate my body." I don't know how that felt to her or to her body, but to me it felt like a slap, and I wasn't even the object of her hatred.

In wondering how her body felt in response to the hatred and rejection she expressed toward it, I remember an episode in Unit II of my training at the Rolf Institute® of Structural Integration. In this phase of the training, students work on each other to learn the Rolfing "Ten Series" of work. The training is intense, requiring students to both give and receive work, as well as to absorb large amounts of information about anatomy and Rolfing theory in a period of about 10 weeks. It's not uncommon as a Unit II student to feel pressured and at your "edges" as a combination of the learning challenges and receiving at least two Rolfing sessions a week. One day the student working on me was doing her pre-session visual analysis, with an instructor observing. She was frustrated with her work and said something like "I fixed the arches in Anne's feet last session and now I don't see the change anymore, what happened?!!" While I intellectually understood her frustration with her learning curve and felt for her, my body had an entirely different reaction: It felt like it locked down and said "well then, screw you, I'm not going to change just to make you happy."

This is why one of the things we learn in Rolfing training is to language change in a way that is supportive. Here's an example: As a practitioner, I could say "Your shoulders are up in your ears, you've got to learn to let them go," which implies complaint, judgement, and an expectation that you change for me. Alternatively, I could say "How would it feel if your shoulders could relax back and settle here?" (using my hands on the mid-back to give a sensory cue). This is language that is meant to evoke, to help the body feel and consider an alternative that might be more comfortable. It's also language that invites the body to participate, rather than to put up resistance and deflector shields in the face of demands for it to change.

Whatever our pain or posture issues are, these bodies we move through life in are a miracle of interconnected functioning. They work so hard for us in the face of our criticisms and judgments ("sit up straight," "you're too fat," "you used to be in shape," "you're looking old"....) Any time you find yourself wishing something were different about your body, I encourage you to take steps toward that betterment, and at the same time to appreciate all that your body does for you despite whatever limitations it may have. That viewpoint makes it easier to enlist all of you in the change you seek.

November 22, 2010

Today I'm following up with another correction to the otherwise decent article on Rolfing® Structural Integration that appeared in USA Today recently. Yesterday's post corrected the article's misconception that Rolfing SI is a form of "massage." The mistake I want to discuss today is the author's neglect to use the Rolfing service mark, and why this is important for the public. (She also did not capitalize Rolfing and follow it with "Structural Integration" as will be explained below.)

What is a Service Mark?

A service mark, designated by "®" after the name, is like a trademark – technicaly, it is a legally protected mark used to identify a brand to consumers. Thus, when you buy "Coke®" you know you are getting a particular brand of cola and you know what to expect; it is not a generic cola that may or may not taste like Coke. Similarly when you buy "Kleenex®" tissues you know they will have a certain softness or texture that you expect, while generic "tissues" are an unknown entity until you try them. In a nutshell, a service mark protects a brand and the quality it represents, while a generic term has no governance. Anyone can throw a liquid in a can and call it "cola," and as we'll see below, anyone can say they do "structural integration" – even with no training – while certification in Rolfing® work as a Rolfer™ tells the public that the person is competently trained.

"Brands" of Structural Integration

Ida Rolf originally called her work Structural Integration, which is now the umbrella or generic name for all work that has a connection back to this original concept. During her life, Dr. Rolf granted the rights to the name "Rolfing" to the Rolf Institute® of Structural Integration, the school she founded to teach her work. Thus, the correct title for Rolfing work is "Rolfing® Structural Integration" – where "Rolfing" is the brand and Structural Integration is the generic form that Rolfing is a specific brand of. Other types of structural integration have other brands: Dr. Rolf's lineage includes, for example, Hellerwork Structural Integration and SOMA Neuromuscular Integration®. The author of the USA Today article seems to have some inkling of this as she identifies Mary Alice Felder as "a structural integration practitioner" (aka, a non-Rolfer who practices structural integration of unspecified training) and Randy Mack as a "Rolfer" (although that should be "Rolfer™" as that too has a trademark).

There should be similarities between all structural integration work (as there are similarities between all "tissues" and all "colas"), but differences too as each offshoot school has its own interpretation and variation of the work and its own unique emphasis. Only practitioners trained at the Rolf Institute® of Structural Integration (RISI), can legally use the terms "Rolfer™" and "Rolfing®," likewise SOMA is service marked, and Hellerwork probably is too, although I couldn't find it on the Hellerwork website. I would never presume to call myself a "Hellerworker" without graduating from their program – in fact I can't tell you exactly what they do as I haven't been to their school or received Hellerwork sessions. So I take umbrage when I hear non-Rolfers say they do "Rolfing" as if they know what that is. Rolfing is what is taught at the Rolf Institute, and if you haven't been there as a student you don't qualify to say what that is and to compare your work to Rolfing. Ideally, other structural integration schools develop their own brands rather than trying to take a free ride on our well-known service mark. When graduates of the various structural integration schools respect each other's service marks, we strengthen our field as a whole and the quality and diversity of our various forms of the work, as well as educating our potential clients about what we each do.

For Consumers: Finding a Qualified Practitioner

However, there's more at stake than a certain "sibling rivalry" between the heirs to Ida Rolf's work: service marks ultimately protect the public from untrained practitioners – those who have never set foot in any structural integration training school. I sometimes hear from clients that their massage therapist or chiropractor "did a little Rolfing work" on them. Usually that person was not trained in Rolfing work or in structural integration at all, but rather imagines that sticking an elbow deeply into a psoas means they are doing Rolfing work. This is false promotion, and if the work is bad it gives Rolfing SI a bad reputation, and if the practitioner is untrained it won't help you and could have an ill effect.

To be sure you are getting a trained practitioner do this: When you are looking for a Rolfer, check the Rolf Institute website to make sure a practitioner is certified as a Rolfer – even if the person says he or she is a Rolfer. Do the same with the Hellerwork site when you are looking for a Hellerworker, the same with the SOMA site for a SOMA practitioner, and so forth. That way you will know you are finding a skilled practitioner and what form of structural integration he or she practices. If someone says he practices one of these modalities, but you cannot confirm it, that is suspect and speaks of the person's lack of integrity, and probably a lack of training as well.

Had the journalist writing in USA Today used service marks correctly and discussed both Rolfing as a brand and structural integration as a whole, she would have educated the public and steered them toward qualified practitioners.

November 21, 2010

Overall, A Decent Article

Rolfing® Structural Integration was again in the news a few days ago, this time USA Today. You can read the article here. It's a decent overview of the work and another example of the resurgence of interest Rolfing has seen lately, following on a New York Times article and a brief appearance by two Rolfers™ on the final minutes of a Today show segment.

I'm always appreciative of media coverage that educates the public about our work and its benefits, and this USA Today article does have a basically accurate overview of our work as well as some good quotes. However, as with many articles about Rolfing work, it has two major errors or misconceptions that I want to address here and in another post tomorrow. Today, I'd like to discuss whether "Rolfing" Structural Integration is "massage" as the USA Today article implies with it's title "'Rolfing' massages make a return."

Rolfing Misconstrued as "Massage"

Rolfers will almost universally tell you that Rolfing work is not massage. My colleague Michael Vilain in Palo Alto sometimes does chair work outside a Whole Foods store, and he says "I ask new people seeing me [there] if they felt that what I did was massage; 9 out 10 people say it's not massage by any means." By many definitions and most imagery in our culture, "massage" means kneading-type work focused on the muscles and either moving blood and lymph through them and lactic acid out of them, or loosening them up. The typical example of this would be Swedish massage. Despite this, the word "massage" tends to be used as an umbrella for all sorts of techniques from Shiatsu to Rolfing SI, even when their methodology and goals are quite different. For example, the methodology of Shiatsu (which I studied in Japan in the 1980s, so I know whereof I speak) is pressure to the acupuncture points and meridians, traditionally to treat illness as well as tension. The methodology of Rolfing work is to organize the fascial or connective-tissue web to align the body in gravity (which along the way helps immensely with tension and pain issues). The methodology of craniosacral work (which I practice too) is to gently release and harmoniously support the complex craniosacral system that includes fluid flows, bones, and membranes. These are completely outside the usual scope of the word "massage." The USA Today article accurately says that Rolfing "practitioners stretch and apply pressure to the connective tissue to restore alignment in the body" but it wrongly says that Rolfing work is "deep massage of the connective tissue."

What Is Rolfing SI If Not Massage?

To illustrate this, the connective tissue is like vacuum packing around every muscle. Think of the connective tissue as a ziplock bag, and the muscle as the contents of that bag. In "massage" you are mushing the contents (the muscle), softening it up and the like. It feels great and helps support healthy muscle function and metabolism, but you are not necessarily affecting the "ziplock bag" of connective tissue – it's size and shape will remain the same. This is why massage typically does not change posture and does not provide more than temporary relief for a structural issue (such as hunched shoulders, tight hamstrings, or other postural issues and the pain they can cause). In contrast, in a Rolfing session the practitioner is working on the connective tissue – changing the shape and size of the ziplock bag –allowing the muscle to reorganize within it and allowing better posture and often a big reduction in pain as the structure comes into better balance and alignment. Change on a connective-tissue level tends to hold well in the body, provided you stretch to keep the "ziplock bags" flexible.

That's how I see it as a practitioner. From another perspective, what one client had to say about Rolfing work versus massage is memorable: "Rolfing is to massage as the Navy Seals are to boy scouts." I discuss that, and how it makes sense in more than a humorous way, in this earlier post.

"Bodywork" Is a Better Umbrella Term

So if Rolfing SI is not "massage," what is it? In the broad field of people who do hands-on work with the body's soft-tissue, we like to use the term "bodywork" as our umbrella term, not "massage." Thus, the bodywork field includes massage, Shiatsu, and Rolfing SI, as well as Polarity Therapy, Tui Na, Breema Bodywork®, craniosacral work, and many others, and also movement disciplines like Feldenkrais and Aston Patterning and others.

However, the media has generally not caught on, and neither have state legislatures. I live in Washington state, and rather than have separate licensing for the handful of Rolfers who live here, it's most convenient for us to be licensed as Licensed Massage Practitioners. In a perfect world, that would be "Licensed Bodywork Practitioners."

Please read the next post tomorrow, to learn about the importance of service marks to guarantee that clients are getting the work they pay for.

November 15, 2010

Today I was sorting some photos and thought I'd share about one pretty unique thing we do in Rolfing® Structural Integration (SI) – seated back work. This typically completes a session, going down the length of the spine, but I will also often do it extensively during a session if I'm working with a client:

-who has upper, mid, or lower back pain, -whose back has gone out, -who has pain sitting, -who has poor posture (kyphosis or lordosis), or -who has limited range of motion in the back or neck.

Here's an image of me working this way on a "Rolfing bench" with a Seattle client's upper back (I have her permission to use these images) – where I'll often have my client turn his/her head to get some rotation through the spinal segments I'm releasing.

And here's another of low back work – helping to get the normal lumbar curve into the spine when the pelvis has become too tucked under (a typical cause of low back pain):

When Rolfer™ Jon Martine appeared on Oprah a couple of years ago, he demonstrated seated back work on Dr. Oz, who asked "What do you call this?" Jon's answer was "Your new best friend," which is quite appropriate as clients love this work.

November 10, 2010

I participated in a radio interview on alternative health in September, talking about Rolfing® Structural Integration specifically. It was a segment of a program called Voices of Diversity on KBCS 91.3 FM in Bellevue, WA. The host of the show, Sonya Green, was great and she had done her homework and asked intelligent questions that led to a good discussion about the benefits of Rolfing work for injuries (auto injuries, sports injuries), postural improvement, and emotional change and transformation.

Go here if you'd like to listen to the archived recording of this show, then scroll down the page until you find the listing for the September 15, 2010 show on Alternative Medicine. The first guest is naturopath Nesreen Medina, and I'm the 2nd guest, from about 15 minutes in until the break at 30 min. [There's an audio problem with my first response (bad mike), then the rest is quite listenable.] Then from the 37 min mark til the end of the hour there's a discussion with Nesreen and me that covers more about Rolfing work and about complementary medicine.

November 02, 2010

In most bodywork trainings – whether Rolfing® Structural Integration or massage – you are taught to stay away from nerves as they are "compression sites." In recent years, however, we've gained an important new understanding of:

1) how nerves can become inflamed and then "tethered" on soft tissue, 2) how inflamed or tethered nerves can be the source of alot of people's pain, and3) how to work gently with the fascia of the nerve sheaths to ease the inflamation and release tethering.

What is an inflamed nerve? This simple metaphor (from Rolfer™ Mark Hutton) explains it beautifully: A happy nerve can roll and glide like a piece of dental floss as you stretch and move; an inflamed or tethered nerve is more like a pipe-cleaner that has a rough surface and will snag on tissue as you move, causing pain.

What causes inflamed nerves? Nerves seem to become inflamed as a result of trauma (auto accidents, falls, blows, dislocations...) and repetitive motion (think carpal tunnel) especially, but I think staying too long in any one posture without counter-balancing stretching can have an impact (e.g., sitting at a desk 8-9 hours a day without moving around).

How do you work with inflamed nerves? The original manual therapy techniques for working with inflamed and tethered nerves came from French osteopath Jean-Pierre Barral, and from Australian PTs. In our Rolfing community, the work has been developed further by Don Hazen – who has some great articles on his website – and by Jon Martine, who first introduced me to this work a couple of years ago. (Hazen believes that inflamed nerves are behind most postural issues too, not just pain issues.) The basic technique is to first identify the inflamed nerve – to sensitive touch, if will feel like a guitar string surrounded by tight or ropey muscle. Then one gently feels for where it is tethered, and works both in to the tension (like you would in undoing a tight knot, the essence of "indirect" technique), as well as gently stretching the nerve sheath out of the tension. This work can be done very gently like craniosacral work, or it can have more fascial work and stretch added making it closer to Rolfing. I find that how I work depends on each client's body and how the tissue responds.

In my Seattle Rolfing practice, I've seen how there are almost always inflamed nerves where the client says s/he has pain. This gentle nerve work, as well as more traditional Rolfing fascial work in the surrounding tissue, has been the missing link for many of my clients with chronic or acute pain. Luckily for our clients, the Rolfing community in general has shown great interest in learning manual therapy for the nerves, and because of this we published five articles on the topic in the June 2010 issue of Structural Integration: The Journal of the Rolf Institute (I'm the Editor-in-Chief, so I helped influence that!). Some of these articles are available at The Ida P. Rolf Library of Structural Integration – do a search for the content "inflamed nerve."